Medical Student Concerns for Respiratory Protection on Anesthesiology Elective

Abstract

Introduction: Anesthesiologists perform aerosolizing procedures including endotracheal intubation, necessitating the use of personal protective equipment (PPE) such as N95 masks during the Coronavirus Pandemic. Medical students rotating on anesthesiology electives are similarly exposed to potential viral transmission during these procedures.

Objective: This study compares student responses to concerns about their respiratory protection in 2020 vs. 2021.

Methods: Medical students rotating on the Adult Anesthesia Elective (2020) and the Anesthesiology & Perioperative Medicine Elective (2021) were assigned to read, “Respiratory Protection for Healthcare Workers” and answer “Do you have any concerns about your respiratory protection?”

61 students completed the assignment in 2020, and 74 students in 2021. These responses were analyzed and coded for themes. 10 themes emerged for students who were concerned with their respiratory protection, and 4 themes emerged for students who were not concerned. Basic percentages were calculated and the number of students expressing various themes in their responses was summed and compared between 2020 vs. 2021.

Results: In 2020, 35% of students were concerned about their respiratory protection, decreasing to 28% in 2021. Reasons for students not being concerned include the availability of PPE, vaccination status, testing patients for COVID pre-operatively, and the option to avoid the risk. Reasons for concern included the aerosol-generating nature of intubation, N95 masks should be single use, patients not being tested for COVID properly and failed fit tests and mask seals (only in 2020), availability of PPE, fear of being a vector, and not doffing properly. Long-term COVID complications and ability to socially distance at work were also concerns in 2020.

Conclusion: Student concern with respiratory protection decreased from 35% to 28% from 2020 to 2021. One of the primary differences is that students were vaccinated in 2021. Students not concerned displayed confidence in PPE availability and patients testing negative for COVID-19 prior to OR procedures. In addition, some students commented on their ability to avoid risk by not caring for COVID-positive patients, although one student commented this hindered their education.

Student concerns included viral transmission during aerosolizing procedures and the observation of N95 mask reuse, which is not advised. Some students were not able to get a fit test due to PPE shortages or had failed their fit test in 2020. Facial hair and having a beard was a concern in both 2020 and 2021 for proper mask fit. Other students feared being an asymptomatic carrier and acting as a vector to their patients and loved ones. Similarly, they worried that the testing window for patients was too wide. Students in both 2020 and 2021 expressed concern about self-contamination from not doffing their PPE properly. A few students commented on the unknown long-term effects of COVID-19 and the inability to socially distance at work.

Generally, students were not concerned with PPE availability and their personal safety in the clinical environment on their anesthesiology elective. As the pandemic continues to evolve, time will tell if we can continue to maintain PPE supplies, effective vaccines, and work to decrease student concerns.